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Ellen Reed is a 37-year-old woman with diabetes. She has three children and works two part-time jobs. Though she has health insurance coverage, she has difficulties navigating the system. The financial burden of paying for her many medicines is also prohibitive. Some months she has to forgo medications in order to pay for essentials for her family, like food and rent.

INTRODUCTION

A woman’s health and social position are intimately entwined. Social inequalities shape women’s illnesses and their options for medical care. Poor women, women of color, and elderly women are particularly affected by social disparities and their consequent impact on health.

Compared with men, women on average possess less social and economic power, are more limited in pursuing higher education and employment opportunities, and shoulder a higher burden of unpaid and hidden work (especially related to family care and community activities). In addition, women are more likely to work in low-wage, high-stress positions in the service industry. All of these inequalities increase women’s vulnerability to poverty.

Poverty, in turn, undermines health. Poor women are at increased risk for acquiring disease and have poorer health in general compared with women with greater economic power. Reproductive health in particular suffers in poverty. Women living in poverty are more likely to acquire sexually transmitted diseases and human immunodeficiency virus (HIV). In some regions of the world, complications of pregnancy and childbirth claim the lives or well-being of a significant number of young women. Complications from disease progression (e.g., infertility secondary to untreated pelvic infection) are more prevalent for poor women who experience difficulties accessing health care. Additionally, because many poor women rely on government insurance for reproductive health care, poor women are most directly affected by the politicization of reproductive health care.

This chapter discusses factors that influence and contribute to women’s vulnerability, especially as it relates to their reproductive health. It concludes by offering strategies for improving reproductive health disparities with a focus on the United States. Issues related to lesbian health are discussed in Chapter 32.

WOMEN’S HEALTH: WHY ARE WOMEN VULNERABLE?

Women in the United States have a life expectancy of 5 years longer than men and lower age-adjusted death rates than men for 12 of the 15 leading causes of death.1 However, many women’s health needs are inadequately addressed.